Category Archives: Health Care

McAuliffe Lets the Cat out of the Bag

by James C. Sherlock

Current Virginia law and Terry McAuliffe cannot coexist.

“A parent has a fundamental right to make decisions concerning the upbringing, education, and care of the parent’s child.”

Code of Virginia § 1-240.1. Rights of parents.

“I don’t think parents should be telling schools what they should teach.”

Terry McAuliffe, Sept 28, 2021

Let’s walk that forward. Progressives all over Virginia and the nation were horrified. They consider McAuliffe’s words to be dogma. But they wish he hadn’t exposed it so publicly. 

During an election bid.

So, now that the cat’s out of the bag, let’s experiment with changes to  § 1-240.1. Rights of parents and see what it takes to make it comport with progressive thinking. Continue reading

Big Lessons from Government Data on Virginia’s 286 Nursing Facilities

by James C. Sherlock

Nursing facilities in Virginia offer an incredible mixed bag. There are heroes and villains. Much to see here.

This column will offer expansive  views of government data on each of the 286 nursing facilities in this state.  

I found out a lot things that really matter to the quality of a nursing facility in Virginia. And a lot of things about government oversight.  nd government insurance payments.

From the visualization aids I provide, so will you.

  • You will find absolutely outstanding facilities.  
  • You will find others that have fallen so short of government standards for so long that you will wonder why Virginia does not revoke their licenses.  
  • You will see the nursing homes in your region.  
  • You will see which chains deliver excellent facilities and which do not, apparently as business models in both cases. Many chains tend to be consistently good or consistently bad. They are color coded in the “Group Ownership” column based upon the overall performance of the chain.  
  • Take a look at the staffing star ratings. Those are based on quarterly filings of data that is linked to payrolls, so it is relatively up to date and relatively accurate. One- or two-star staffing is a very bad sign.
  • You will see the stunning outperformance of nursing facilities in continuing care facilities in Virginia, also as a function of business models.
  • Nursing home inputs — people — enter nursing homes in much different physical conditions and ages. You will see that where you live is a statistical predictor of health. And therefore of the nursing home challenges in areas of poor health. Which tracks with areas of poverty. And low government insurance payments.

Finally, take a look at the Inspection activity.  

It reflects the massive understaffing of the VDH inspectors. Look at the “Last standard (full) health inspection” column. You will see coded in red that 42 (15%) of Virginia’s nursing facilities have not been fully inspected since 2018.  The federal requirement is once a year.  

You will be convinced by the data that strict and timely government oversight is required to ensure, and ensure Virginians of, of nursing facility quality.  

The state must fix the statutory and budget issues that have resulted, purposely, in Office of Licensure and Inspection staffing shortfalls. Continue reading

Nursing Home Ads Pose As Official State Advice

by James C. Sherlock

The Virginia state government has a Department for Aging and Rehabilitative Services. 

Who wouldn’t want one of those?  

But in the case of recommending nursing homes, it would be better if it would either stop or fix its broken system. Which it pays a nonprofit, VirginiaNavigator, to run.

It is offering nothing more than free, self-written advertisements for good and bad nursing homes alike under the guise of a state recommendation to seniors. Continue reading

Bacon Bits: Bafflement, Confusion… and Hope

What is wrong with this picture? Headline from FFXnow: “Inova temporarily closes urgent care centers in Reston and Tysons due to high patient volume.” On top of an influx of COVID-19 cases fueled by the Delta variant, Virginia hospitals are getting more patients — many of whom had delayed seeking medical care due to the pandemic — with more medically complex conditions. The health system closed the two facilities to “manage an influx of patients without overwhelming exhausted staff.” I get the part about the staff being exhausted. But how does closing the two centers do anything to solve the patient overload? Inova says it is consolidated staff from the shuttered centers “to better accommodate patient volume.” Huh? No explanation of how that works. 

Build a rail line and they will come A newly launched Richmond-to-D.C. passenger rail line is the first project under the Northam administration’s $3.7 billion, 10-year passenger rail program which, due to protests, COVID-19 and culture wars, has warranted almost zero scrutiny. In this piece in Energy News Network, Danny Plaugher, executive director for Virginians for High Speed Rail, says the new line, which will generate a predicted 12,600 passengers annually, show how serious Virginia is in its commitment to high-speed rail. Aside from getting passengers off the highway, rail is touted as a way to reduce CO2 emissions in the all-consuming war on Climate Change. While the Northam administration is spending billions on rail, here’s what’s happening in the real world: Road and highway travel is recovering from the epidemic, while rail traffic is not. The most recent quarterly ridership for the Virginia Railway Express (VRE) commuter rail service in Northern Virginia, for example, is down 85% in 2021 compared to the same period in 2019.

A massive win for Southwest Virginia. A joint venture between Blue Star Manufacturing and American Glove Innovations has committed to invest $714 million to establish the most the world’s most advanced (NBR) manufacturing facility to produce nitrile rubber gloves. The project would repatriate production of an estimated 60 billion gloves annually from Asia to the United States. Based in the Progress Park in Wythe County, the project will employ a predicted 2,500 people within five years. According to the Virginia Department of Economic Development, it represents  “the largest job creation in Southwest Virginia in a generation.” As part of the deal, the state has promised to invest $8.5 million to upgrade water and wastewater capacity at the industrial park. The nitrile glove market is expected to grow 9% annually through 2027.

Virginia’s Self-Inflicted Nursing Home Crisis – Part 5 – The Best facilities in Virginia

by James C. Sherlock

To show you the list of nursing facilities that I would use to begin a search for one for me and my family, I have built a spreadsheet of the very best facilities in Virginia.

Because they are available, I made it a true list of all stars. Five stars composite rating and not a single individual rating below four stars.

There are 40 of them, surprisingly and welcomingly spread around the state. If you read my previous posts, or read the notes on the spreadsheet, I don’t have to comment extensively.

Eight of them are for-profits.  So it can be done. Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 4 – the Worst Facilities in Virginia

by James C. Sherlock

Today we are going to take a look today at a snapshot of Virginia’s worst nursing homes as rated by the Centers for Medicare/Medicaid services.

Medicare rates 54 of the total of 386 nursing facilities in Virginia as overall one star out of five.  By definition of the way that Medicare compiles records and assigns scores, they have been bad for a long time.

Don’t use them. If you have any friend or loved one in one of these places encourage them to re-locate if they can. Either way, visit them often. It helps.

The ratings are established in considerable part by the inspections conducted by the Virginia Department of Health Office of Licensure and Inspection.

Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 3 – McAuliffe & Herring

by James C. Sherlock

In the first two parts of this series, I wrote about the shortage of state inspectors for nursing homes in the Virginia Department of Health Office of Licensure and Certification (OLC)  and the continuing danger it poses to Virginia patients.

The problem, unfortunately, is much wider than just nursing homes.  So is the scandal.

That same office inspects every type of medical facility including home care agencies as well as managed care plans. Except it cannot meet the statutory requirements because it does not have sufficient personnel or money. And it have been telling the world about it for years.

Terence Richard McAuliffe was the 72nd governor of Virginia from 2014 to 2018. Mark Herring has been Attorney General since 2014.

We will trace below that they can reasonably be called the founding fathers of overdue inspections of medical facilities in Virginia.

VDH has been short of health inspectors since McAuliffe and Herring took office and still is .

Both of them know it. And they know that lack of inspections demonstrably causes unnecessary suffering and death.

Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis — Part 2, the Business

by James C. Sherlock

Nursing homes are businesses.

Seventy percent of those in Virginia are for profit. They are run not by doctors but registered nurses with physicians on call. 

Nursing facilities very widely in size in Virginia, from the 300-bed Mulberry Creek Nursing and Rehab center in Martinsville to facilities of less than 30 beds, especially the long-term care units of a few mostly rural hospitals.

They include facilities designated as skilled nursing facilities (SNF), often post-op care and rehabilitation, and others designated as long-term-care nursing facilities (NF). Most nursing homes in Virginia have facilities and certified beds for each.

Insurer mix and staffing costs are keys to profitability.

Many of these businesses are worth what they get paid, but many are not. Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 1

by James C. Sherlock

None of us ever knows when we will need a nursing home for ourselves, our parents or our kids. Yes, kids.

While long-term nursing care is mostly for older patients, skilled nursing facilities are needed for patients of all ages, including children, for shorter term post-op treatment and recovery.

The patients in many of Virginia’s nursing homes suffer greatly from a combination of known bad facilities and a lack of government inspections. The health and safety of patients in those facilities are very poorly protected by the state.  

In this series of reports I am going to point out some nursing homes (and chains) whose records will anger you. Government data show some have been horrible for a very long time in virtually every region in the state.

Those same records show that Virginia is years behind on important, federally mandated health and safety inspections.

VDH’s Office of Licensure and Certification doesn’t have enough inspectors — not even close. And the government of Virginia — officially based on budget data — not only does not care but is directly and consciously responsible.

When I am done reporting on my research I suspect you will demand more inspectors.

You will also  reasonably ask why the worst of them are still in business when the Health Commissioner has the authority to shut them down.

Good question. Continue reading

Follow the Science. Whose Science?

Image by Katja Fuhlert from Pixabay

James Earl Biden. Yesterday was supposed to be the day when almost all American adults could start getting the first booster shot for the Pfizer vaccination. On August 18 the Biden Administration announced that a Pfizer booster shot would be available to Americans who received their second Pfizer dose at least eight months prior. At the time of the announcement, Biden said, “This will boost your immune response. It will increase your protection from COVID-19.  That’s the best way to protect ourselves from new variants that could arise.”

While the Biden announcement contained the usual boilerplate notation that approvals had to be secured from the FDA and CDC before the booster program could begin, it seemed obvious that the administration expected approval.

The scheduled date for broad based Pfizer booster shots came and went yesterday without a broad based booster program. Continue reading

Nine Years Later, Bon Secours Still Hasn’t Made Good on Promises

With help from Redskins cheerleaders, then-Richmond Mayor Dwight Jones announces the $40 million Redskins training camp deal. Photo credit: Richmond Times-Dispatch

by James A. Bacon

In October 2012, the City of Richmond negotiated a $40 million deal with the Washington Redskins and the Bon Secours Virginia Health System to build a Redskins training camp in the city. The complex deal had many moving parts. To make it happen, the city gave Bon Secours a long-term lease on the property of the old Westhampton School site so it could build a medical facility in the city’s prosperous West End. In exchange for favorable lease terms and the right to sponsor the training camp, the Richmond-based health system agreed to construct a medical office and fitness center in the poor, inner-city East End where it also operated the Richmond Community Hospital.

“This agreement will allow Bon Secours to significantly expand upon our effort to build healthier communities across Richmond,” CEO Peter J. Bernard said in a news release at the time.

Bon Secours did build the fitness center. But nearly a decade later, no ground has broken for the medical office.

Time is running out for the company to make good on its agreement, warn Michael Schewel, former executive vice president of Tredegar Corp., who served as Secretary of Commerce and Trade under Governor Mark Warner, and Steve Markel, chairman of the Markel Corp.

“They’ve gotten an extension from the EDA (Economic Development Authority) and they’re absolutely at the end of their time,” says Schewel. They’ve got to get a building permit, build a building, hire people, and get it done within a year of Jan. 1. It takes six months just to get a building permit from the city!” Continue reading

Hospitals Experiencing a COVID Crunch

COVID-19 hospitalizations in Virginia. Source: Virginia Department of Health

The media is full of stories about how the rebound in COVID-19 cases fueled by the Delta variant is putting hospitals under the most stress since the peak of the epidemic in February. Hospitals are rapidly filling up. Some are reporting shortages of beds, others of staff. Making matters worse, hospitals from other states, also inundated by COVID, are so desperate they are poaching nurses from Virginia.

In no way do I minimize the current challenges facing hospitals. But it is important to maintain clarity about what’s going on. Hospitals are not feeling a crunch because hospitalizations have reached the same level as during the peak. You can see clearly in the graph above that hospitalizations are running about one-third the level of February.  Continue reading

Correction: Vaccination Advantage Exaggerated

by Steve Haner

Twenty to one?  Where did that math challenged fellow get that?  Oh, wait, I am the math challenged fellow and I have to offer a big correction to my post from yesterday.  Yes, the advantage to being vaccinated is evident in that new data set on the Virginia Department of Health dashboard, but the advantage is not that large.

Over the period measured, January 17 to February 14, a vaccinated person had about a 15 to one advantage over an unvaccinated person (2 versus 31 out of 100,000) when considering risk of death, and slightly better than ten to one (9 versus 98 out of 100,000) when considering risk of hospitalization.   The blatant error I made probably reflected a bias to see that advantage, having gotten the shots and hoping the hesitant will come around.

Still pretty dramatic, you say.  There is more bad news.  The data is week by week, and looking at the most recent weeks, those gaps have dropped substantially.  One week’s data is a small snapshot but looking at all the weeks in July (probably fairly complete now) a trend of smaller gaps is evident.    Continue reading

Enough Inefficiency to Go Around

by Dick Hall-Sizemore

Folks here on BR seem to take great pleasure in pointing out and criticizing the shortcomings and inefficiencies of government. I have spent my entire professional career working in state government and I have suffered through more than my share of meetings at which nothing was decided and have seen a lot of inefficiency and some incompetence (though not nearly as much incompetence as some would have us believe exists). So, I can understand these complaints and agree with a lot of them.

However, what has always irritated me is the assumption, both implicit and explicit, that the private sector is always better. Somehow, the private sector is sacrosanct and, thus, is immune from criticism.

A recent experience provides me a two-fer — an opportunity to point out shortcomings not only in the private sector, but, as a bonus, in private medical services, as well. After consulting with an orthopedist, I decided to have a metal plate, implanted in my wrist many years ago, removed because it was causing some problems. It was a relatively simple outpatient procedure. Continue reading

VDH Data: Vaccinated Improve Odds by 20 to 1

Virginia Department of Health

According to the Virginia Department of Health’s count, just more than 400 fully-vaccinated patients have ended up in a Virginia hospital with a case of COVID-19, and 83 have died. This was the count for the period of January 17 to August 14 and represented five percent or less of the total hospital cases and deaths in that period. The percentages are even smaller when compared to the pool of 4.7 million fully vaccinated people.

So. being vaccinated is safer than being unvaccinated by a factor of about 20. Your odds of staying out of the hospital or morgue improve 20 to one. Out of every 100,000 vaccinated Virginians, nine ended up in the hospital and two died. Among the millions of unvaccinated and partially vaccinated, 164 per 100,000 went to the hospital and 55 died. Partial vaccination is not that useful.

The website is proving glitchy today, probably swamped with visitors. VDH had promised an update for this data set last Friday, but then delayed the release to today. As it is it is still a week behind, but weekly updates are promised. Death stats in particular are slow to arrive. Apparently, they are cross referencing with the state database of vaccinated individuals, and a previous Bacon’s Rebellion post raised other issues about that. Continue reading